Working out can reduce disease's spread and recurrence

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, 纽约邀请您成为“知情患者”，收听播客，介绍来自纽约中部唯一学术医疗中心的专家. I'm your host, Amber Smith. Maintaining an exercise routine may not be your top priority during cancer treatment, but there are benefits to being active. We'll hear about that from my guest, Dr. Kaushal Nanavati. He's an assistant professor of family medicine at Upstate, who is also the director of integrative medicine and survivorship at the Upstate Cancer Center. Welcome back to "The Informed Patient," Dr. Nanavati.

[00:00:37] Kaushal Nanavati, MD: Thank you, Amber. It's been a long time.

[00:00:39] Host Amber Smith: Several health organizations have general exercise recommendations. Dr. Nanavati，在接受癌症治疗时，有关于锻炼的权威建议吗?

[00:00:50] Kaushal Nanavati, MD: So there are, actually, several cancer organizations that have recommendations based on the best known current evidence. And the information and evidence change, and as they do, the recommendations do periodically change as well. 所以美国癌症协会是很多人寻求建议的首要组织, but, there are recommendations from multiple societies.

[00:01:16] Host Amber Smith: Do we have evidence that it's actually safe to exercise during cancer treatment?

[00:01:22] Kaushal Nanavati, MD: Not only do we have evidence -- it's recommended. 对于很多人来说，他们忘记的是当你谈论癌症对一个人的生活的影响时, if we just think about, so first of all, let's go back a step. When we say cancer, what that really means, it's a family of conditions. It's a whole compendium. And so one cancer does not equate to another. And someone who has cancer, during their journey through cancer, their body goes through different stages, different phases, and so even their body at different times will be able to tolerate different things.

All of that being said, as a broad stroke general recommendation, the value of exercise, if I put it in the cancer context, three main points to really bring up. One is that it's been known, through evidence, that exercise reduces the potential for onset of certain cancers, especially when you think about breast cancer, colorectal cancer, endometrial and gastric cancer, esophageal cancer, kidney cancer, and specifically with lung cancer, for people that smoke, exercise reduces their risk of lung cancer. So that's just the risk of getting it.

And for people who have cancer, exercise reduces the rate of recurrence, especially when it comes to things like certain types of breast cancer. So now we're talking about recurrence.

Then we think about cancer therapies. Exercise, through the literature, 已经被证明可以提高治疗的效果并且有助于减轻身体的癌症负担, whether it be reducing the spread of cancer, what we call metastatic disease. So high intensity exercise, in one study, actually showed that it reduced the potential for spread of cancer by nearly 72%. That's huge. Right? And high intensity activity isn't something that necessarily everybody does, but clearly there's some potential benefit for the right person in the right condition.

And then the idea of side effects of cancer chemotherapies, right? Whether it's immunotherapy or chemotherapy, or just going through the cancer journey. People experience mental fatigue, physical fatigue, emotional drain, and even the side effects of things like bone thinning, heart toxicity, cognitive decline, all of these things have been shown to benefit. When somebody has exercise, they actually experience less of the side effects and more of the benefits.

[00:04:03] Host Amber Smith: I want to ask you a little more specifically about the types of exercise, 但我认为，根据每个人患的癌症类型，建议可能会有所不同, or how progressed it is, or where they are in their treatment.

[00:04:18] Kaushal Nanavati, MD: So that's exactly right. And on the other hand, as a baseline, 我们可以说，任何处于任何癌症阶段的人都可以从体育锻炼中受益.

Physical activity includes basic things like going for a walk, riding a bicycle, going up and down the stairs, that type of stuff. And then there's more intense forms of activity. We think about exercise in terms of aerobic and anaerobic activity. So aerobic is the standard cardiovascular stuff that people think about, whether it's walking, jogging, treadmill, bikes, swimming, that type of stuff. And the anaerobic stuff relates to things like weight-based training.

So the current guidelines for exercise, 以前是每周150分钟的有氧运动然后是几次举重训练. The latest guidelines actually encourage up to 300 minutes of aerobic exercise per week, along with two to three sessions of weight-based training per week.

So, ultimately, 你最终会发现每周大约有三到五个小时或三到七个小时的锻炼时间, if you include the weight-based training, to give the biggest kind of value for people who have cancer and for people who don't.

[00:05:38] Host Amber Smith: What about less vigorous things like relaxation exercises like yoga or even tai chi. Do those count as movement and exercise?

[00:05:48] Kaushal Nanavati, MD: They count and have their own value, actually, in terms of not only helping a person with things like balance and coordination, if they've had side effects of their treatment, but relaxation therapy has an impact on the biochemistry and hormones in the body. And so things like deep breathing exercise or practice.Some people meditate. Some people just do deep breathing. Walking in nature, as a reflective exercise. Tai Chi. Yoga. Pilates. All of these things actually have an impact biochemically in boosting the immune system, 这在很多情况下是有价值的，同时也有利于减少组织，肌肉和关节的炎症, improving flexibility.

And so overall wellbeing improves, but specifically not only the physical, but the mental, emotional, biochemical and hormonal constitution of a person's body actually gets better as well.

[00:06:46] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking to director of integrative medicine, Dr. Kaushal Nanavati from the Upstate Cancer Center, and we're talking about the benefits of exercise during cancer treatment.

所以让我们更具体地谈谈对刚开始锻炼的人有好处的锻炼, that hasn't really done a whole lot of activity in the past and now they're in cancer treatment. What types of things would you recommend for that person?

[00:07:17] Kaushal Nanavati, MD: Start low and go slow. Right? And I'm smiling as they say that for those that really can't see us anyway. You know, the key is what you want to do is be consistent. 有一项研究表明，每周锻炼三次30分钟的人与每天锻炼10分钟的人相比, the ones that did 10 minutes a day were more likely to make it a habit.

So the key is really to get started. This morning my thought was to embark, right, to begin the journey. The most important thing is taking that first step. So for those people that haven't exercised regularly, make it a part of your routine. Make it a non-negotiable so that everything else works around that.

For me, before I go to work in the morning, I have my exercise time. And then if I have time later in the day, I may exercise more or go for a walk in the evening with my wife or my family, et cetera. But fundamentally, I get my self-care time in in the morning because I know that once the day gets going, sometimes we get busy, things come up, et cetera. But first thing in the morning, we can actually plan for it. So I encourage people who haven't started to even plan for five or even 10 minutes, depending on their physical ability.

And more importantly, I will put the caveat that if you haven't exercised regularly, 确保你和你的医疗保健提供者一起工作，并确保你足够健康，可以开始锻炼. 然后他们，或者他们会帮你联系一个能指导你如何最佳锻炼的人. 在北州，我们的优势是拥有多种专业和专家. 我们甚至有一位理疗师专门研究癌症患者的身体活动. So we're going to have more and more resources available, which I'm really excited about because everyone has different ability. At the same time, every cancer type has a different impact on the body. And depending on how it's impacting one person versus the other, 我们可以更具体地说明我们提出的建议的类型和人们可以采取的方法.

But there are fundamental things we all do during the day. And as long as we're more active than we are sedentary, there's value. One of the things that exercise does, actually, which I think is fascinating biochemically, is it actually has an impact on reducing cancer metabolism. So what I mean by that is, if you exercise very vigorously, what happens is your muscles need the blood flow, 哪一种能把它从那些渴望它，吵嚷着争夺它的癌细胞中偷走. And so if you're exercising and the muscles are getting the blood flow, the cancer cells are getting less of it, which can eventually lead to starving them out. And, 生化运动实际上在细胞内起作用，诱导癌细胞自然死亡, so that we can actually get rid of them faster. So that is amazing stuff that we don't even think about.

[00:10:15] Host Amber Smith: What about athletes who are used to working out at a high level? Do they ever have to take it down a few notches?

[00:10:22] Kaushal Nanavati, MD: So the best answer in medicine that we always teach our students is, "it depends."

So it depends, Amber. 我的意思是这取决于个人，取决于他们患的是什么类型的癌症. In many instances, they may have to take it down a notch, especially if they're experiencing fatigue, bone pain, if there's stress on their heart because of the treatment or the therapy that they're getting, if they're having impact on their cognitive function, et cetera. Or it's metastasized somewhere else, let's say, to the bone or muscle.

当然，我认为从久坐的人到经验丰富的运动员或竞技运动员都是如此, 从根本上说，我们必须确保他们所做的不会增加他们身体的压力负荷, on their heart, and on their skeletal structure as well. And then give them a green light as to the degree of intensity, frequency, duration, all those things they can do. 但这并不意味着他们不能活跃也不意味着他们仍然不能竞争或参与活动因为他们能够忍受这是由他们所患的癌症类型决定的.

[00:11:31] Host Amber Smith: Does it matter whether the person exercises indoors or outdoors?

[00:11:36] Kaushal Nanavati, MD: So if they're exercising, I'm smiling, right? Because they're already doing the thing. Outdoors and indoors, in terms of what the evidence suggests, as long as they're doing it, there's value.

我们知道日光对情绪、认知、注意力和愉悦感都有好处. At the same time, if it's February in Syracuse, then you've got to be careful as to what the weather is outside as well.

So, it is variable. At the end of the day, doing the exercise is where the greatest value is. And then the environment should be one that supports somebody's sense of joy, versus stresses them out. And that's the way they can kind of figure it out as to what works best for them.

[00:12:19] Host Amber Smith: I've heard that oncology treatments can weaken the immune system, so do you have any concerns regarding group exercise classes, where the person would be surrounded by other people who are exercising?

[00:12:33] Kaushal Nanavati, MD: Yeah, actually that is something to consider, 这是需要注意的，因为潜在的感染，比如病毒感染, et cetera, is higher, especially if you're sharing equipment or it's not cleaned properly from user to user. Then we have to be careful.

Also, oftentimes when you're in physical exercise environments with groups, not everybody is necessarily practicing optimal hygiene. And even if they are, if they have a cough or they have a cold, then the potential for risk is higher for a cancer patient, especially if they're on some type of immune suppressing treatment.

And so they do have to be careful about that. 是的，有时候你喜欢这种情感上的支持，一个群体的支持是令人振奋的. And at the same time, in terms of exercise itself, you still have to be careful.

[00:13:23] Host Amber Smith: Well, on that note, 有什么要注意的，这样你就不会做得太过火了，或者有什么风险吗, just to be aware of?

[00:13:33] Kaushal Nanavati, MD: I think the most important thing one has to gauge is, 1, their ability,and 2, pair that with their health providers' recommendations, specifically their oncology team and their primary care providers, since between the two of them, their health is assessed, not just in terms of their cancer diagnosis, but their overall health in the context of their life, in terms of their goals.

And so that becomes the important thing. You know, people will hear exercises good for you, and then just start doing it. But, you know, when you jump start the system, sometimes there's a little bit of stress that comes with that. So, taking a gradual approach to increasing it, but being consistent.

There's a great quote by (actor) Denzel Washington that talks about dreams are just dreams, but in order to achieve those dreams -- I'm paraphrasing -- it requires discipline. It requires consistency. 我认为，当涉及到体育锻炼时，关键是要坚持，就像营养一样. And I do have to put a plug in that exercise and nutrition go hand in hand. So when people do better with both, 它提高了他们的整体健康，显然创造了一个环境，让他们有更好的机会在他们的身体里有一个抗癌的环境.

[00:14:55] Host Amber Smith: We talked about sort of the ideal amount of time being three to five to seven hours a week, kind of spread across the week. 但是对于那些与疲劳作斗争，有时只是为了度过一天而挣扎的人呢. Do you have any advice for that person?

[00:15:14] Kaushal Nanavati, MD: Yeah, actually it is exercise, because what happens is when it comes to cancer-related fatigue, we know that people that exercise actually have improved energy. And so, they may not start with an hour a day. But what they can do is start with two minutes or five minutes, get up to 10 minutes.

We also know from other studies that if you get 10 minutes of cardiovascular exercise, aerobic exercise that's actually good for your heart. We also know that people that tend to exercise more consistently actually have improved energy.

So, it's kind of like, if I don't do it, I'll remain tired, but if I do it, I might be tired in the moment, but over time I'll actually have better and better energy, improved stamina, and that actually helps in the long term.

[00:16:01] Host Amber Smith: Is there a value to building in a rest day where you don't do aerobic stuff, or you don't do weight training, you just sort of let your body rest?

[00:16:12] Kaushal Nanavati, MD: That depends on the person and depends on the intensity of what you're doing. If you're going for walks every day you can go for walks every day. If you are going to be doing a power lifting competition, or you're going to be doing something engaged competitively or training for a marathon, then you have to kind of do what's right for your body, giving moments of rest. Especially when you do longer endurance or strength-based more intense activities, then your body does need time to recover, depending on how intensely you're doing it. For people that are doing moderately intense activity and / or low intensity activity, generally speaking, they can remain consistent throughout the week.

[00:16:53] Host Amber Smith: At the beginning of this interview, 我们谈到了将医学治疗与运动相结合的综合疗法的好处, and you also brought up nutrition. Do we understand, in the body, what it is that is happening that helps reduce the spread of cancer, potentially, or reduce the risk of cancer? What is happening, like, at a cellular level?

[00:17:18] Kaushal Nanavati, MD: A ton of stuff, I'll tell you. Everything from impact on dopamine to immunoglobulins, 影响细胞结构从而导致细胞晚期死亡并减缓癌症的发展, slow down the spread of cancer, what we call metastatic disease, what we call proliferation or growth of the cancer.

There are multiple, multiple enzymes and hormones and chemicals that are affected, 包括我们所说的细胞因子和一些人听说过的血管内皮生长因子蛋白质, something called mTOR, (mammalian target of rapamycin) multiple, multiple enzymes that get affected.

In fact, the other thing that ends up happening is, it actually has an impact even on the blood supply to cancer cells and reducing that, as I mentioned, with higher intense activity. So, everything from regulating the metabolism of cancer, how much it gets for nourishment, to regulating the immune environment in the body to keep our immune system stronger, to reducing the cancer risks, as I mentioned, to reducing the cancer related side effects. 所有这些，结合起来，都是通过持续的体育锻炼来实现的.

[00:18:34] Host Amber Smith: Well, this is really good to know and very important information. I appreciate you making time for this interview.

[00:18:40] Kaushal Nanavati, MD: 我真的很感激，因为我同意这真的是把权力放回到一个人的手中，能够驾驭他们的生活经历, even with a diagnosis of cancer, recognizing that you want to be, you want to live like you're living, and you want to have the best quality of life moving forward, regardless of the diagnosis, to the best of your ability.

[00:19:02] Host Amber Smith: My guest has been Dr. Kaushal Nanavati, an assistant professor of family medicine at Upstate, who is also the director of integrative medicine and survivorship at the Upstate Cancer Center. "The Informed Patient" is a podcast covering health, science, and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at nhfilmexpo.com/informed. If you enjoyed this episode, please rate and review "The Informed Patient" podcast on Spotify, Apple, YouTube, or wherever you're listening. This is your host, Amber Smith, thanking you for listening.